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Comment & Response |

Training for Effective Patient Communication—Reply

J. Randall Curtis, MD, MPH1; Anthony L. Back, MD2; Ruth A. Engelberg, PhD1
[+] Author Affiliations
1Division of Pulmonary and Critical Care, University of Washington, Seattle
2Department of Medicine, University of Washington, Seattle
JAMA. 2014;311(13):1356-1357. doi:10.1001/jama.2014.1475.
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In Reply Dr Smulders takes issue with our comment that patients’ ratings of communications skills may have limitations. We did not intend to suggest that patients were not important evaluators of communication. Patient perceptions are crucial. However, when the conversation involves topics that patients do not want to talk about, or find uncomfortable or sad, patient ratings may have limitations as an outcome measure for several reasons.

First, patients may have little experience with other clinicians to help form a judgment. Second, their own emotions raised by the conversation may be more influential in their rating than what the clinician said or how he or she said it. Third, some patients may judge optimism preferable to straightforward discussion of prognosis, even when it is unrealistic or leads to misinformation. A recent study found that, for patients with advanced cancer, better understanding of their prognosis was associated with lower ratings of physicians’ communication.1

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December 4, 2013
J. Randall Curtis, MD, MPH; Anthony L. Back, MD; Dee W. Ford, MD, MSCR; Lois Downey, MA; Sarah E. Shannon, PhD, RN; Ardith Z. Doorenbos, PhD, RN; Erin K. Kross, MD; Lynn F. Reinke, PhD, RN; Laura C. Feemster, MD, MS; Barbara Edlund, PhD, ARNP; Richard W. Arnold, MD; Kim O’Connor, MD; Ruth A. Engelberg, PhD
1Harborview Medical Center, Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle2Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle
3Seattle Cancer Care Alliance, Division of Medical Oncology, Department of Medicine, University of Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington
4Division of Pulmonary and Critical Care, Department of Medicine, Medical University of South Carolina, Charleston
1Harborview Medical Center, Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle
2Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle
2Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle5VA Puget Sound Health Care System, Health Services Research and Development, Seattle, Washington
1Harborview Medical Center, Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle5VA Puget Sound Health Care System, Health Services Research and Development, Seattle, Washington
6College of Nursing, Medical University of South Carolina, Charleston
7Department of Medicine, University of Washington, Seattle
JAMA. 2013;310(21):2271-2281. doi:10.1001/jama.2013.282081.
April 2, 2014
Yvo Smulders, MD
1Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands
JAMA. 2014;311(13):1355. doi:10.1001/jama.2014.1757.
April 2, 2014
Diane B. Wayne, MD; William C. McGaghie, PhD
1Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
2Ralph P. Leischner Jr, MD, Institute for Medical Education, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
JAMA. 2014;311(13):1355-1356. doi:10.1001/jama.2014.1763.
April 2, 2014
Masako Sugihara, MD, MA
1Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
JAMA. 2014;311(13):1356. doi:10.1001/jama.2014.1766.
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